Jose Acuchi prepares yellowfin tuna at a San Francisco restaurant. Fish is healthy, but can expose diners to methylmercury that may harm fetuses.

Jose Acuchi prepares yellowfin tuna at a San Francisco restaurant. Fish is healthy, but can expose diners to methylmercury that may harm fetuses.

Photo: Paul Chinn, The Chronicle

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Eliseo Castillo tags yellow fin tuna at Ports Seafood in San Francisco, Calif., on Friday, Jan. 14, 2011. A statewide study revealed that tuna and swordfish samples collected from grocery stores and restaurants contained as much as three times the level of mercury deemed harmful by federal standards. less

Jose Acuchi cuts into a swordfish at Ports Seafood in San Francisco, Calif., on Friday, Jan. 14, 2011. A statewide study revealed that tuna and swordfish samples collected from grocery stores and restaurants contained as much as three times the level of mercury deemed harmful by federal standards. less

Jose Acuchi cuts into a swordfish at Ports Seafood in San Francisco, Calif., on Friday, Jan. 14, 2011. A statewide study revealed that tuna and swordfish samples collected from grocery stores and restaurants ... more

Photo: Paul Chinn, The Chronicle

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Few pregnant women warned about chemicals

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When Dr. Darragh Flynn sits down with her pregnant patients, she preaches healthy habits: eat nutritious foods, take vitamins, and don't smoke or drink.

She also advises them to avoid gasoline fumes, pesticides, certain types of fish, and some household cleaners and cosmetics.

"It's only for nine months," the San Francisco doctor tells the women. "Let someone else put gas in the car."

But Flynn is in the minority. A new UCSF survey of 2,600 obstetricians and gynecologists nationwide found that most do not warn their pregnant patients about chemicals in food, consumer products or the environment that could endanger their fetuses. More than half said they don't warn about mercury, and hardly any of them give advice about lead, pesticides, air pollution, or chemicals in plastics or cosmetics.

Many doctors say their priority is to protect pregnant women from more immediate dangers, and that warning them about environmental risks may create undue anxiety. Some say they don't feel confident in their ability to discuss the topics.

"We're worrying about preterm labor, obesity and hypertension," said Dr. Jeanne Conry, an OB/GYN at Kaiser Permanente in Roseville (Placer County), and incoming president of the American Congress of Obstetricians and Gynecologists. "Obesity trumps almost everything. We put our time and energy there and don't dwell on some of the other things we should be aware of."

Virtually all pregnant women have chemicals in their bodies that might harm fetal development.

Monitoring of pregnant women found about 100 chemicals, with 43 of them in all women tested. Lead, mercury, toluene, perchlorate, bisphenol A, flame retardants, perfluorinated compounds, organochlorine pesticides and phthalates are among the chemicals, according to the U.S. Centers for Disease Control and Prevention's nationwide testing program.

Studies suggest that for many these compounds, low-level exposures in the womb disrupt development of the brain or reproductive systems. Others may raise the risk of birth defects, or lead to cancer, immune problems, asthma, fertility problems or other disorders later in life.

Yet that information is not reaching most women who are pregnant or may become pregnant.

Almost all of the doctors in the new UCSF survey said they routinely discussed smoking, alcohol, diet and weight gain. Eighty-six percent also said they discuss workplace hazards, and 68 percent warn about secondhand smoke.

But only 19 percent said they talk to their pregnant patients about pesticides and only 12 percent discuss air pollution. Forty-four percent said they routinely discussed mercury with pregnant women. Eleven percent said they mention volatile organic compounds, which are fumes emitted by gasoline, paints and solvents.

Even fewer physicians warned their patients about two chemicals in consumer products that are often in the news: bisphenol A (BPA) at 8 percent and phthalates at 5 percent. Nine percent of the doctors told their patients about polychlorinated biphenyls (PCBs), industrial compounds often found in fish.

The results show a disconnect between environmental health research and what the physicians do - and do not - tell their patients, said Patrice Sutton, a research scientist at UCSF's Program on Reproductive Health and the Environment, who helped design the survey.

The goal of the study, which was discussed at a recent conference but is not yet published, was to try to break down obstacles that keep health messages from pregnant women.

For instance, even though the dangers of mercury are well established, only 4 out of every 10 doctors said they discuss the contamination with pregnant women.

Since 2004, the U.S. Environmental Protection Agency and the Food and Drug Administration have warned pregnant women to avoid eating high-mercury fish such as swordfish and shark and to limit consumption of albacore tuna. In addition, the American Congress of Obstetricians and Gynecologists issues statements to its members on the importance of patients' avoiding mercury in fish.

Yet an estimated 300,000 newborns each year - one out of every 14 - are exposed to levels of methylmercury that exceed the guidelines set by the EPA to avoid neurological effects in fetuses. Mercury in the womb has been tied to lower IQs and other effects on developing brains.

Dr. Naomi Stotland said warnings about mercury could result in women eating less fish, a low-calorie protein rich in omega-3 fatty acids critical for a baby's brain development.

"Mercury in fish is a tricky one," said Stotland, a San Francisco General Hospital doctor and lead investigator on the survey. "Fish is such a good protein source for women, and they're probably not eating enough of it. I give out printed materials that direct them to fish with lower levels of mercury," such as sardines, herring, pollack, shrimp and scallops.

"Most of my patients don't even read food labels. Are they carrying around the fish list? I worry, and I know other colleagues worry, that women will replace fish with processed hamburger. I don't think it's such a simple message."

Dr. Jane Hightower, who practices internal medicine in San Francisco, agreed that the warnings are confusing but said OB/GYNs should take more time to learn about food and contaminants.

"To make ends meet, there are too many patients crammed into the (doctor's) schedule. Food science literature and environmental toxicant literature are difficult to sort out, and the doctors are not being taught about nutrition or contaminants in school," said Hightower, who has written a book and scientific journal reports about unhealthy levels of mercury in fish.

Despite evidence that environmental factors contribute to many health problems, medical students report fewer than six hours of environmental health training, according to University of Texas School of Medicine researchers.

"The whole medical establishment needs to look at themselves and start evaluating old practices that might not be so safe for the patient in the long run," Hightower said.